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<br /> " 0 Dealer/seller I ❑Lender I ❑Escrow/title agent I ❑ Owner/buyer I ❑ Legal representative
<br /> Name:HOMES DIRECT OF OREGON LLC MILLERSBURG
<br /> Address(including city,state,and ZIP):3838 PALM HARBOR DR MILLERSBURG OR 97321
<br /> Phone:541-928-2083
<br /> Email:MARK.GORMAN@HOMES.DIRECT
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<br /> to 1' '.t. .L x HOME INFO' mATION {*reefult6d).,, hr ;
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<br /> Home ID number(if known): DMV X-plate number(if known):
<br /> 62bDC,o48
<br /> ❑Moving in from another state
<br /> Has no home ID or X-plate because: ❑Coming out of county deed records
<br /> [Nil Other:
<br /> Manufacturer:PALM HARBOR Model:3 1 0 LtCA 213 5'la2.4 Year:2$1$
<br /> Manufacturer serial number I HUD number
<br /> PHH 310 O R IS( tueriLA p- ORE 5'c.4 0 2,7,..A.
<br /> :„
<br /> PHH '3IO Oe,le( — ‘Z(Q '"l 13 ORE5L( () 2- 5
<br /> *Number of sections: 2 . I *Square footage: (ittri I *Number of bedrooms: ?j I *Number of bathrooms: 2..,-.
<br /> *Type of roofing: Q,Ytif\ I *Type of siding: Cay.204 I *Heating: �l I *Cooling:NONE
<br /> `a'' *Date of sale: 3_3 0 - 2 I *Sales price: 71 Lc q ,op *Includes land: ❑Yes 0 No
<br /> -DEALER INFORMATIO (if no dealer leave blank) :
<br /> Dealer name: Dealer license number: Dealer address and phone:
<br /> HOMES DIRECT OF OREGON LLC MSD-523 3838 PALM HARBOR DRIVE
<br /> MILLERSBURG MILLERSBURG OREGON 97321
<br /> [This manufactured structure is free and clear of all mortgages,deeds of trust,security interests,and liens.I have the
<br /> legal right to sell this manufactured structure.
<br /> I hereby declare that the above statement is true to the best of my knowledge and belief,and that I understand it is
<br /> made for use as evidence in court and is subject to penalty for perjury.
<br /> Dealer n�amee(.,,,
<br /> rint�)f:Q( � Dealer sip. ature: 1 Jo ' Date: 2/2S'1�l
<br /> „/I/' ./.� .-.lig 411 Al . II . 40'.
<br /> TRANSPORTER INFORMATION (if not movin leave blank) •
<br /> Transporter name: Transporter address and phone:
<br /> BENNETT TRUCKING 409 BIGHAM BROWN ROAD ,
<br /> EAGLE POINT OREGON 97524
<br /> 541-879-3444 JACKIE YOUNG
<br /> 440-2952(7/19/COM) Page 2
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